Valve Disease. Valve Surgery Volume, Volume (N = 2798)

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1 Valve Disease Valve Surgery, (N = 79) 3 In 1, surgeons performed 79 valve surgeries. A total of 17 were primary operations and were reoperations surgeons have implanted more than 1,5 bioprosthetic aortic valve replacements since the 199s, with excellent short- and long-term outcomes. Outcomes 1

2 Valve Surgery In-Hospital Mortality (N = 79) Surgical Isolated AVR Transcatheter AVR AVR + CABG % % % % MVR Isolated + CABG MV Repair Isolated MVR Septal Myectomy N = The 1 in-hospital mortality rates for all types of valve surgery were lower than expected at. STS expected Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database 1 Abbreviations: AVR = aortic valve replacement, CABG = coronary artery bypass grafting, MV = mitral valve, MVR = mitral valve replacement, TAVR = transcatheter aortic valve replacement Aortic Valve Surgery 1 (N = 17) In 1, a total of 17 aortic valve procedures were performed at Sydell and Arnold Miller Family Heart & Vascular Institute 9

3 Valve Disease (continued) STS Rating for Coronary Artery Bypass Grafting + Aortic Valve Replacement ranked among the top.3% of US hospitals for coronary artery bypass graft (CABG) surgery plus aortic valve replacement (AVR), earning the Society of Thoracic Surgeons (STS) 3-star rating for this category (based on data from July 1, 13, to June 3, 1). This denotes the highest category of quality. Participant Score (95% Confidence Interval) STS Mean Participant Score Participant Rating 95.% 91.% (9.9-9.) STS Min. 1th th 9.7 9th 9.3 Max 99. = STS mean participant score Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database 1 Isolated Aortic Valve Replacement Complications (N = 37) 1 1 STS expected % Deep Sternal Wound Infection Postop Stroke Postop Renal Failure Postop (Any) had lower-than-expected rates of complications for isolated aortic valve replacement surgery. Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database 1 3 Outcomes 1 3

4 STS Rating for Aortic Valve Replacement ranked among the top % of US hospitals for aortic valve replacement (AVR) surgery, earning the Society of Thoracic Surgeons (STS) 3-star rating for this category (based on data from July 1, 13, to June 3, 1). This denotes the highest category of quality. Participant Score (95% Confidence Interval) STS Mean Participant Score Participant Rating 97.% 9.3% ( ) STS Min. 1th th 9.7 9th 9.3 Max 99. = STS mean participant score Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database 1 Combined Aortic Valve Replacement & CABG Surgery, In-Hospital Mortality (N = 9) 1 1 % Primary STS Aortic valve replacement, in combination with coronary artery bypass graft (CABG) surgery, is a complex operation. Despite this complexity and the associated increase in risks, in-hospital mortality rates for both primary operations and reoperations were low. Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database 1 Sydell and Arnold Miller Family Heart & Vascular Institute 31

5 Valve Disease (continued) As world leaders in mitral valve repairs, Cleveland Clinic surgeons have performed 3 robotically assisted mitral valve repairs in the past 5 years (1 1). The mortality rate was.% (N = 1) compared with the expected rate of 1% 1.%. Source: Data from the UHC Clinical Data Base/Resource Manager TM used by permission of UHC. All rights reserved. Mitral Valve Surgery, Repair vs Replacement Repair Replacement performs mitral valve repair procedures rather than replacement whenever possible. Mitral valve repair is associated with better survival, improved lifestyle, better preservation of heart function, and a lower risk of stroke and infection (endocarditis) compared with mitral valve replacement. Repair procedures also do not require postprocedure anticoagulation therapy. Isolated Mitral Valve Surgery, In-Hospital Mortality (N = 5) 1 STS expected % Replacement % Repair The 1 in-hospital mortality rates for patients who had isolated mitral valve surgery were lower than expected for both repair and replacement procedures. Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database 1 3 Outcomes 1

6 Surgical Treatment of Active Infective Endocarditis Bacterial (infective) endocarditis is a life-threatening infection of the heart valves or the heart s inner lining (endocardium). The condition causes growths on or holes in the valves or scarring of the valve tissue, most often resulting in a leaky heart valve. surgeons treat patients with infective endocarditis, including those with advanced disease and prosthetic valve endocarditis (N =13) 15 Primary In 1, surgeons performed 13 valve procedures to treat patients with infective endocarditis. A total of were primary operations and 7 were reoperations. Infective Endocarditis Primary Operation, In-Hospital Mortality 1 1 Infective Endocarditis, In-Hospital Mortality Observed 1 % Observed 1 % Source: Data from the UHC Clinical Data Base/Resource Manager TM used by permission of UHC. All rights reserved. 33 Sydell and Arnold Miller Family Heart & Vascular Institute 33

7 Valve Disease (continued) Transcatheter Aortic Valve Replacement is a national leader in the use of percutaneous treatment options for patients with valve disease. Transcatheter Aortic Valve Replacement, and In-Hospital Mortality 1 (N = 33) Mortality (%) 1 A total of 33 patients had transcatheter aortic valve replacement (TAVR) procedures at in 1. The in-hospital mortality rate was 1.7% compared with an expected rate of 7.9%. 1 1 Observed Source: Data from the UHC Clinical Data Base/Resource Manager TM used by permission of UHC. All rights reserved. Since the inception of the transcatheter aortic valve replacement (TAVR) program in, has become a world leader in the use of this specialized treatment in patients carefully selected based upon stringent clinical criteria. More than 7 patients have had this procedure at with great success. There were 1 in-hospital deaths in the -patient cohort (11 1, average age 1.15 years), which represented a 1.9% mortality rate compared with the expected rate of.%. 3 Outcomes 1

8 Transcatheter Aortic Valve Replacement, In-Hospital Mortality (N = ) A total of patients had transcatheter aortic valve replacement procedures at Cleveland Clinic from January 11 through December 1. The in-hospital mortality rate was 1.9% compared with the expected rate of.%. Transcatheter Aortic Valve Replacement, by Approach (N = ) 11 1 (%) Transapical Transfemoral Transaortic Subclavian Other (transcarotid, transaxillary) N = The majority of transcatheter aortic valve replacement procedures performed at from January 11 through December 1 were done using a transfemoral approach. Sydell and Arnold Miller Family Heart & Vascular Institute 35

9 Valve Disease (continued) Valve Surgery Primary Operation and (N = 79) Primary Operation surgeons performed 79 valve procedures in 1. A total of % were reoperations on patients who had previous open heart surgery. Valve Surgery Primary Operation and In-Hospital Mortality (N = 79) 1 First Surgery Patients who have valve surgery reoperations have a somewhat higher risk of death compared with patients who have primary surgery. This is due to the overall decrease in health over time. Despite this, the in-hospital mortality rates for patients were lower than expected for reoperations as well as for primary procedures. Source: Data from the UHC Clinical Data Base/Resource Manager TM used by permission of UHC. All rights reserved. 3 Outcomes 1